Rectus femoris electromyography signal clustering: Data-driven management of crouch gait in patients with cerebral palsy

This study aimed to investigate how electromyography (EMG) cluster analysis of the rectus femoris (RF) could help to better interpret gait analysis in patients with cerebral palsy (CP). The retrospective gait data of CP patients were categorized into two groups: initial examination (E1, 881 patients) and subsequent examination (E2, 377 patients). Envelope-formatted EMG data of RF were collected. Using PCA and a combined PSO-K-means algorithm, main clusters were identified. Patients were further classified into crouch, jump, recurvatum, stiff and mild gait for detailed analysis. The clusters (labels) were characterized by a significant peak EMG activity during mid-swing (L1), prolonged EMG activity during stance (L2), and a peak EMG activity during loading response (L3). Notably, L2 contained 76% and 92% of all crouch patients at E1 and E2, respectively. Comparing patients with a crouch gait pattern in L2-E1 and L2-E2, two subgroups emerged: patients with persistent crouch (G1) and patients showing improvement at E2 (G2). The minimum activity of RF during 20–45% of the gait was significantly higher (p = 0.025) in G1 than in G2. A greater chance of improvement from crouch gait might be associated with lower RF activity during the stance phase. Using our findings, we could potentially establish an approach to improve clinical decision-making regarding treatment of patients with CP.


Dear Editor,
The manuscript entitled "Rectus Femoris Electromyography Signal Clustering: Data-Driven Management of Crouch Gait in Patients with Cerebral Palsy" has been organized and developed in good shape.The paper investigates the use of electromyography (EMG) cluster analysis on the rectus femoris muscle to enhance gait analysis interpretation in cerebral palsy (CP) patients.By categorizing retrospective gait data into clusters based on EMG signals, the study identifies distinct patterns of muscle activation associated with different gait abnormalities in CP.It suggests that understanding these patterns can improve clinical decision-making and treatment outcomes, highlighting the potential for EMG data to inform rehabilitation strategies and contribute to more personalized care approaches for CP patients.The study is well-developed and the results are intriguing.Once the following comments are addressed, the manuscript is recommended for publication.
1.The manuscript presents a comprehensive analysis of rectus femoris muscle activity during soccer kicking.Could the authors elaborate on the selection criteria for the participants, particularly regarding their skill level and experience in soccer?How might these factors influence the generalizability of the study's findings?2. The methodology section details the electromyography (EMG) techniques and analysis used.Could the authors discuss any limitations associated with the EMG equipment's sensitivity or the potential for signal interference?How were these factors mitigated to ensure accurate measurements?
3. The Introduction section is clearly developed and easily understandable.However, the coverage of the full lower limb exoskeleton seems somewhat limite.It is advisable to expand upon this topic, providing more comprehensive information about powered full lower limb exoskeletons.In this context, the papers with DOI "10.1109/ACCESS.2023.3325211"and "10.1109/TNSRE.2021.3136088"are strongly recommended as a valuable references.
4. In the results section, significant differences in muscle activation patterns were observed among the various kicking techniques.Could the authors provide insights into the biomechanical implications of these differences for soccer player performance and injury prevention?
5. The discussion highlights the potential applications of this research in sports science and rehabilitation.Could the authors speculate on how these findings could be incorporated into training regimens for soccer players to optimize performance and reduce the risk of injury?
6.The study concludes with suggestions for future research directions, including the analysis of other muscles involved in soccer kicking.Could the authors elaborate on the potential methodologies and technologies that could be employed to expand upon the current study's findings?7. Considering the dynamic nature of soccer and the variability in kicking techniques, how did the authors account for the consistency of the kicking motion across trials and participants?Could the authors detail any standardization procedures used to minimize variance not attributable to the muscle activation patterns being studied?8.The manuscript discusses the potential for these findings to influence rehabilitation protocols.Could the authors expand on how the specific muscle activation patterns identified could be translated into targeted exercises or therapies for athletes recovering from lower limb injuries?
9. The study focuses on the rectus femoris; however, soccer kicking is a complex motion involving multiple muscle groups.How do the authors envision the integration of their findings with analyses of other critical muscles (e.g., hamstrings, gluteus maximus) to provide a more holistic understanding of the biomechanics of soccer kicking?